| NPI | 1114572385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA PARDO Licensee (Local) 760-405-1505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320700000X Residential Treatment Facility, Physical Disabilities |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2019-08-05 |